AAO Exam 2 Pathologies

Acromioclavicular separation and degrees of injury

Commonly used to describe the various amounts of ligament injury at the AC joint. 1st degree sprain - AC ligament is stretched 2nd degree sprain - AC ligament is ruptured/the coracoclavicular ligament is stretched 3rd degree sprain - both AC ligament and coracoclavicular ligaments are ruptured

Clavicular fractures

Most frequently broken bone in children, usually result from a fall on the lateral aspect of the shoulder or on the outstretched hand, usually breaks in midportion

Pulled elbow (nursemaid's elbow)

seen in young children under the age of 5yo who have experience a sudden strong traction force on the arm; ex: adult pulls arm, or child falls when arm is being held in place

Scaphoid fracture

sometimes associated with damage to the blood vessel that supplies this bone which can lead to avascular necrosis

Gamekeeper's thumb

stretching injury of ulnar collateral ligament of thumb, most often occurs due to fall on an outstretched hand

What is swimmer's shoulder?

swimmer that specializes in freestyle, butterfly and backstroke commonly affected. overuse condition that involves compression between the acromial arch, the humeral head and the soft tissue structures (coracoacromial ligament, rotator cuff muscles, long head of the biceps, subacromial bursa)

Bicipital tendonitis

usually involves the long head of the biceps proximally as it crosses the humeral head, changes direction, and descents into the bicipital groove; rupture of the biceps long head tendon commonly occurs during repetitive or forceful overhead positions

Ganglion cyst

a benign, fluid filled cyst commonly seen as a bump on the dorsal surface of wrist; can appear, disappear and change size quickly; treatment only necessary if painful or interferes with function

Median nerve compression

affects ligament of struthers, biceps aponeurosis, pronator teres, flexor digitorum superficialis, transverse carpal ligament (see carpal tunnel syndrome)

Colles fracture

break in distal radius at the level of the metaphysis and is common injury in the elderly; transverse fracture of distal radius includes a posterior displacement of the distal fragment

Carpal tunnel syndrome

caused by compression of the median nerve within the carpal tunnel; symptoms include - numbness, tingling in hand which often begins at night; c/o tingling,pain, weakness in hand, particularly in the thumb, index and middle fingers. Tapping over the carpal tunnel often produces symptoms; possible tx is surgically cutting the transverse carpal ligament (not all fibers or it would lead to bowstringing Thenar m. affected because of compression of the reccurent branch of the median n. - can cause thenar wasting; Biggest functional implication - loss of thumb opposition

Humeral neck fracture

caused by fall on outstretched hand, common in elderly = impacted

De Quervain's disease

caused by inflammation and thickening of the sheath containing the extensor pollicis brevis and abductor pollicis longus resulting in pain on the radial side of wrist

Calcific tendonitis

chronic inflammation of the supraspinatus tendon can lead to accumulation of mineral deposits; asymptomatic or quite painful

Skier's thumb

common in athletes; involves acute tear of the ulnar collateral ligament of thumb

Wrist sprains

common when a person falls on outstretched hand; wrist usually hyperextended when it hits the ground; most commonly injured ligament is scapholunate ligament.

Glenohumeral subluxation

commonly seen in individuals who have hemiplegia, usually from CVA; paralysis of the shoulder muscles leaves them no longer able to hold the head of the humerus in the glenoid fossa; combined with the pull of gravity and the weight of the arm, over time causes the partial dislocation

Radial nerve pasly

compression of radial n. leads to wrist drop; inability to extend wrist, fingers and thumb; common place of compression is the radial groove of the humerus; can occur with humeral fracture

Cubital tunnel syndrome

compression of ulnar n. at cubital tunnel

Guyon's canal compression

compression of unlar n. at guyon's canal

Labral tear

damage to the glenoid labrum; degenerative or traumatic; results in pain and limited ROM

Avascular necrosis

death of bone tissue

Smith's fracture

distal fragment is displaced anteriorly (opposite of colles fracture)

Elbow dislocation

great deal of force is applied to an elbow that is slightly flexed; causes ulna to slide posterior to the distal end of the humerus

Greenstick fracture

incomplete fracture, usually the radius and more proximal than Colles fracture; more common in children

Spiral fracture

increases risk of radial nerve injury as the nerve passes over the bone in the spiral groove

Tenosynovitis

inflammation of tendons and their surrounding sheaths

Medial epicondylitis (golfer's elbow)

inflammation of the common flexor tendon that inserts into the medial epicondyle. Overuse condition that results in tenderness over the medial epicondyle and pain on resisted wrist flexion.

Thoracic outlet syndrome

interscalene triangle (middle and anterior scalene), costoclavicular space (1st rib and clavicle), subcoracoid space

Klumpke's Palsy

involvement of C8 and T1 sometimes C7 nerve root; Moro reflex present/absent; loss of grasp reflex; wrist flexors, long digital flexors and the intrinsic muscles of the hand are impaired; muscles controlling shoulder and elbow are usually spared; hand is supinated/ wrist extended/ fingers clawed.

Torn Rotator cuff

involves distal tendinous insertion of the supraspinatus, infraspinatus, teres minor, and subscapularis (SITS) on the greater/lesser tubercle area of the humerus. Tears can be the result of acute trauma or gradual degeneration

Subluxing of the biceps tendon (long head)

irritation as it slides into bicipital groove; overloading the muscles in an abducted and laterally rotated position tends to be the force subluxing the tendon out of the bicipital groove.

Dupuytren's contracture

occurs when the palmar aponerosis undergoes nodule thickening; most common in area of palm in line with the ring and little fingers - often develop flexion contractures

Pathological fractures of the humerus caused by

of the humerus can be caused by benign tumors or metastatic carcinoma from primary sites such as lung, breast, kidney, prostate.

Midhumeral fracture

often caused by a direct blow or a twisting force

Supracondylar fractures

one of the most common fractures in children; caused by falling on an outstretched hand. Distal end of the humerus fractures just above the condyles.

Anterior shoulder dislocations

one of the most common joint dislocations; a forced shoulder abduction and lateral rotation tends to be the dislocating motion causing the humeral head to slide anteriorly out of the glenoid fossa.

Lateral epicondylitis (tennis elbow)

overuse condition that affects the common extensor tendon where it inserts into the lateral epicondyle of the humerus; the extensor carpi radialis brevis is particularly affected

Impingement syndrome

overuse condition that involves compression between the acromial arch, the humeral head and the soft tissue structures (coracoacromial ligament, rotator cuff muscles, long head of the biceps, subacromial bursa)

Little leauge elbow

overuse injury of the medial epicondyle, usually by repetitive throwing motion. Often seen in children that have not reached skeletal maturity. Throwing motion places, a valgus stress on the elbow, causing lateral compression and medial distraction on the joint.

Risk of elbow dislocation and supracondylar fractures

potential damage to brachial artery

Stenosing tenosynovitis (trigger finger)

problem with the sliding mechanism of a tendon and its sheath; when a nodule or swelling of the sheath lining or tendon develops, the tendon can no longer slide in and out smoothly

Erbs Palsy (tip position)

raction injury to baby's upper brachial plexus and often occurs during difficult childbirth Affected arm hangs down in shoulder extension/medial rotation/elbow extended/forearm pronated/ wrist extended Involves C5 and C6; common Impaired functions of deltoid, external rotators of the shoulder, elbow flexors and wrist extensors; supraspinatus, infraspinatus, teres minor, biceps brachii, brachialis, supinator, brachioradialis

Radial nerve compression

radial groove, leash of henry, arcade of fohse, supinator, lateral intermuscular septum, fibrous band of brachioradialis, between brachialis and extensor carpi radialis brevis, distal brachioradialis; sensory distribution of hand and thumb

Volkmann's ischemic contracture

rare but potentially devastating ischemic necrosis of the forearm muscles - cause by damage to brachial artery

Ulnar nerve compression

"hitting the funny bone" - impact to nerve can create pain, numbness, and tingling in the medial hand and 4th and 5th fingers affects arcade of struthers, medial intermuscular septum, subluxing of medial head of triceps, cubital tunnel, flexor carpi ulnaris, guyon's canal - Leads to clawing of the ring and small fingers, the lower the compression the more clawing

Adhesive capsulitis

- inflammation and fibrosis of the shoulder joint capsule, which leads to pain and loss of shoulder range of motion (aka frozen shoulder)